Physician employment contracts with hospitals that were signed in the early days of healthcare reform are coming up for renewal.

Experts say the expectation of payment reform requires that these new deals include the flexibility to adapt to expected and unforseeable changes.

“We're seeing a fair amount of handwringing in terms of these deals,” said Max Reiboldt, president and CEO of the Coker Group, an Alpharetta, Ga.-based healthcare consultant. “We are changing the paradigm of how doctors are being paid. It's not 100% (relative value unit) productivity anymore.”

That said, the predominant payment system has not changed yet and probably won't before contracts expire. So Reiboldt said many new employment contracts are including automatic renegotiation triggers if, for example, 20% of a hospital system's reimbursement starts to involve pay-for-value metrics.